Minimally invasive procedures for facial rejuvenation and remodeling have exhibited exponential growth throughout the world, consequently being accompanied by a concurrent increase in the number of complications. Complications can range from mild (edema, erythema, scarring, granuloma, nodules, abcess formation and paresthesia) to severe, such as vascular emergencies with severe sequelae like disfiguring skin necrosis, blindness and stroke. Practitioners should be aware of the signs and symptoms of these injuries and be ready to promptly implement treatment to improve the odds of therapeutic success.

To date, duplex high-frecuency ultrasound is the first-line imaging in aesthetic medicine. Beyond it’s multiple use in diagnostic, identification of facial anatomic layers, vascular mapping and guided injections with a maximum of accuracy, ultrasonography becomes a fundamental tool in the assessment and treatment of filler’s complications. In this regard, ultrasound is successfully used from precise location and identification of a wide range of fillers when bad cosmetic outcomes are present, to guided procedures in severe catastrophic vascular events. 

We share our experience in ultrasound-guided management of filler’s complications in distinct facial regions (temporal, undereye, cheeks, lips and mandible) and update treatment strategies that helps practitioners to reduce risk and improve outcomes, focusing on the prevention and management of the filler’s complications with the use of high-frecuency duplex ultrasound, a valuable instrument in daily practice.